SEC Form 4 · accession 0001192482-15-000206
COLLEGIUM PHARMACEUTICAL, INC · COLL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Alan D Frazier
10% Owner
James N Topper
10% Owner
Nader J Naini
10% Owner
FHM VI, L.L.C.
10% Owner
FHM VI, L.P.
10% Owner
Frazier Healthcare VI, L.P.
10% Owner
Nathan R Every
10% Owner
Period of report
May 12, 2015
Accepted (ET)
May 14, 2015 · 4:06 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001267565
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2,F3 | May 12, 2015 | C | 582,490 | — | A | 582,490 | D | |
| Common StockF1,F2,F3 | May 12, 2015 | C | 222,231 | — | A | 804,721 | D | |
| Common StockF1,F2,F3 | May 12, 2015 | C | 392,113 | — | A | 1,196,834 | D | |
| Common StockF1,F2,F3 | May 12, 2015 | C | 540,498 | — | A | 1,737,332 | D | |
| Common StockF3 | May 12, 2015 | P | 150,000 | $12.00 | A | 1,887,332 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A Convertible StockF3,F1,F2 | — | May 12, 2015 | C | 4,019,183 | D | — | — | Common Stock | 582,490 | 0 | D |
| Series B Convertible StockF3,F1,F2 | — | May 12, 2015 | C | 1,533,399 | D | — | — | Common Stock | 222,231 | 0 | D |
| Series C Convertible StockF3,F1,F2 | — | May 12, 2015 | C | 2,705,585 | D | — | — | Common Stock | 392,113 | 0 | D |
| Series D Convertible StockF3,F1,F2 | — | May 12, 2015 | C | 3,676,078 | D | — | — | Common Stock | 540,498 | 0 | D |
Explanation of responses
- F1All series of Convertible Preferred Stock automatically converted into Collegium Pharmaceutical, Inc. common stock on a 1-for-6.9 basis immediately prior to the closing of the initial public offering and had no expiration date.
- F2Reflects the conversion of preferred stock into Collegium Pharmaceutical, Inc. common stock on a 1-for-6.9 basis which became effective on May 12, 2015.
- F3This report is filed jointly by Frazier Healthcare VI, L.P. ("FHVI"), FHM VI, L.P. ("FHM LP"), FHM VI, LLC ("FHM LLC"), Nathan Every ("Every"), Alan Frazier ("Frazier"), Patrick Heron ("Heron"), Nader Naini ("Naini") and James Topper ("Topper"). The shares are held by FHVI. The general partner of FHVI is FHM LP, a limited partnership, the general partner of which is FHM LLC. The members of FHM LLC are Every, Frazier, Naini, Heron, and Topper. These individuals share voting and investment power over the shares held by FHVI. Each of these individuals disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest.